Electrocardiograms in athletes: interpretation and diagnostic accuracy.

Area of Science:

• Cardiology
• Sports Medicine
• Preventive Cardiology

Background:

• Sudden cardiac death (SCD) in young athletes is a critical concern.
• Preparticipation examinations (PPE) aim to identify athletes at risk for SCD.
• Electrocardiography (ECG) is proposed to enhance PPE's detection capabilities.

Purpose of the Study:

• To evaluate the effectiveness of ECG screening in detecting cardiac conditions in young athletes.
• To review the current literature on ECG use in cardiovascular screening of athletes.
• To compare ECG screening protocols and their impact on SCD rates.

Main Methods:

• Conducted a Medline literature review using keywords related to athlete cardiovascular screening and SCD.
• Examined ECG findings in specific cardiac disease states relevant to athletes.
• Analyzed data on ECG sensitivity, specificity, and false-positive/negative rates.

Main Results:

• ECG screening can significantly increase the sensitivity of PPE for detecting cardiac conditions, from 2.5-6% to 50-95%.
• Overall sensitivity is approximately 50%, with potential false-positive rates up to 40% and false-negative rates of 4-5%.
• European ECG screening programs show a decline in SCD rates, but US recommendations are lacking due to cost, interpretation standards, and data limitations.

Conclusions:

• While some advocate for ECG screening in young athletes, further research is essential.
• Defining a normal ECG in athletes and validating screening protocols' superiority in disease detection and life-saving are crucial.
• A proposed interpretation scheme and decision tree are offered for clinicians.